A critical assessment of morcellation and its impact on gynecologic surgery and the limitations of the existing literature

Abstract

Uterine sarcomas are rare uterine malignancies that are difficult to diagnose preoperatively. Because of cases of disseminated sarcoma after laparoscopic hysterectomy, the role of power morcellators in gynecologic surgery has been questioned. Morcellation is an integral part of making laparoscopic surgery possible for the removal of large uterine leiomyomata, and the development of power morcellation has increased efficiency during these procedures. Minimally invasive surgery has demonstrated benefits that include improved pain control, decreased infection risk, and faster surgical recovery and return to work. In this review, we examine the risk of incidental sarcoma at the time of surgery, the quality of the data, the accuracy of clinical and radiologic predictors of uterine sarcoma, and the impact of morcellation on the prognosis of uterine sarcoma.

Management of Leimyosarcoma: A Survey Among Members of the Korean Gynecologic Oncology Group

“…34Y38 However, those reports were highly biased and of low quality; thus, whether power morcellation up-stages occult LMS and affects survival is still an open question. 39,40 Therefore, large prospective studies focusing on the effects of morcellation in LMS are warranted. Furthermore, to make decisions on appropriate types of surgery, it will be necessary to identify the most accurate and reliable preoperative diagnostic tools.…”

Risk of Occult Uterine Sarcoma in Women Undergoing Hysterectomy for Benign Indications

“…When developing their recommendations, the FDA used available reports of occult sarcoma in a pooled analysis to derive an estimate of 1:352 risk of occult sarcoma in women undergoing hysterectomy or myomectomy for presumed myomas. Their estimate has been criticized based on concerns about the quality of the data of the 9 studies included, as well as the potential for publication bias and inclusion of only retrospectives studies (17)(18)(19). The largest study in the pooled analysis included only 1429 patients.…”

Safety of Using Electrical Morcellation and Strategies to Reduce Incidental Diagnosis of Uterine Sarcoma

“…In particular, the chance of dispersing fragments of tissue in multiple directions in both benign and malignant conditions [7,8]. That risk is independent of the form in which morcellation is carried out.…”